Diagnosis of Infertility in Women
by Cynthia M. Johnson, MA
Infertility affects about 10% of women. The chance of women without infertility problems getting pregnant after six months of trying is 50% to 65%. The chance after 12 months is more than 85%. The chance after 18 months is more than 95%.
A diagnosis of infertility is made in a heterosexual couple when the woman hasn't gotten pregnant after a full year of regular sex without contraception. The diagnosis can be made earlier if there are known risk factors, irregular menstrual cycle, or increased age.
You will be asked about your symptoms. A family and health history will be taken. You will be asked about:
A physical exam will be done. It will include a pelvic exam, Pap smear, and an exam of your breasts and thyroid gland.
Ovulation Tests and Tests of Ovarian Function
Many tests are used to see if you have been ovulating and to predict when you might ovulate again. Ovulation testing is also used to find out your ability to produce eggs. It is also used to find out if your uterus is able to have an embryo attach to it during the second half of your menstrual cycle (after ovulation and just before your period).
Basal Body Temperature (BBT)
Taking your BBT (at rest, when you first wake up) and recording it on a chart is a way to find out if you have ovulated and when ovulation happened. Your BBT rises at ovulation. It stays high during the second half of your cycle and during pregnancy.
Blood tests measure hormone levels. Estrogen and luteinizing hormone (LH) rise just before ovulation. High levels of the hormone progesterone are a sign that ovulation has happened recently. Your doctor may also measure other hormones to check your overall endocrine function.
Transvaginal ultrasound is used to track the growth of the follicle. This is the place in the ovary where the egg matures. The follicle grows during the first half of your menstrual cycle (from the beginning of your period until ovulation).
Tests of Ovarian Function
Day 3 FSH
This blood test is taken on day three of your menstrual cycle (the third day of bleeding). It measures follicle-stimulating hormone (FSH). This is made by the pituitary gland that controls the growth of eggs. High levels may be a sign that a woman’s ovaries are not working the right way. Very low levels can stop a woman from producing eggs.
Day 3 Estradiol Tests
This blood test measures estrogen in your blood. Levels that are very high may be a sign of poor egg quality.
Day 21 Serum Progesterone
This blood test measures circulating progesterone. It should be higher about one week after ovulation. Levels that are low may be a sign of poor ovulation.
Diagnosing Uterine and Other Physical Problems
Many tests can be done to find out whether the anatomy of the uterus, fallopian tubes, and vagina is normal.
A pelvic exam can show abnormalities, including problems like uterine fibroids. These are benign, muscular tumors in the uterine wall. They can distort the uterus, block the cervix or fallopian tubes, or get in the way of the uterine blood supply the embryo needs to implant and grow.
HSG is an x-ray of the uterus and fallopian tubes. It may be done in the first half of the menstrual cycle. Water- or oil-based dyes are used to find structural abnormalities.
An ultrasound probe is put in the vagina to take a picture of the pelvic organs.
A hysteroscope (tiny telescope with a fiber optic light) is put through the cervix to look inside the uterus and find abnormalities that may have been seen in an HSG.
Laparoscopy is surgery. It is done using general anesthesia. Your doctor will put a small camera and fiber optic light through a small cut in your navel. This lets the doctor get a clear view of your pelvic cavity, including your ovaries, the outside of your fallopian tubes, and uterus. If abnormalities are found, such as adhesions or endometriosis, a laser mounted on the scope can be used to remove them.
Evaluating infertility. The American Congress of Obstetricians and Gynecologists website. Available at:
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Updated October 2017. Accessed December 31, 2018.
Infertility in women. EBSCO DynaMed Plus website. Available at: http://www.dynamed.... Updated November 6, 2018. Accessed December 31, 2018.
Patient history taking: major systems of the body. EBSCO Nursing Reference Center website. Available at: https://www.ebscoh.... Updated March 30, 2018. Accessed December 31, 2018.
Last reviewed December 2018 by EBSCO Medical Review Board Beverly Siegal, MD, FACOG
Last Updated: 1/2/2019
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